Rituximab
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Neutropenia and disseminated cryptococcosis in an elderly patient: case report A 65-year-old woman developed late-onset neutropenia and disseminated cryptococcosis during treatment with rituximab for non-Hodgkin’s lymphoma. The woman was diagnosed with diffuse large B-cell lymphoma in June 2005, and received 4 cycles of CHOP (doxorubicin, cyclophosphamide, vincristine and prednisolone) on days 1-5, every 4 weeks. She also received rituximab 375 mg/m2 [route not stated] on day 1 of the second, third and fourth CHOP cycles. Lenograstim was administered for neutropenia following each cycle. Three days after completing the fourth cycle, she was hospitalised with fever an nausea. She had a leukocyte count of 160/µL with 0% neutrophils, and a chest x-ray showed pleural effusion on the left lung. The woman was treated with cefepeme. Blood and pleural fluid cultures were positive for Cryptococcus neoformans, and she began receiving fluconazole. Her neutropenia resolved, and she was discharged on hospital day 63. Six days later, she was rehospitalised with neck stiffness, ambulation difficulty, chills and nausea. Her leukocyte count was 1090/µL with 72.5% neutrophils. CSF examination showed an opening pressure of 260mm H2O, a protein level of 161 mg/dL and a leukocyte count of 598/µL. CSF culture was positive for C. neoformans, and she was treated with amphotericin B, flucytosine and fluconazole. On hospital day 20, CSF examination revealed an opening pressure of 210mm H2O, a protein level of 35 mg/dL and a leukocyte count of 128/µL. A diagnosis of rituximab-induced late-onset neutropenia was made. She began receiving lenograstim, and was discharged on hospital day 139. In October 2009, she received R-CHOP for a relapse of non-Hodgkin’s lymphoma, with no recurrence of rituximab-induced late-onset neutropenia. She achieved second complete remission of non-Hodgkin’s lymphoma in October 2010, but continued to experience ambulation difficulty. Hirai Y, et al. Disseminated cryptococcosis in a non-Hodgkin’s lymphoma patient with late-onset neutropenia following rituximab-CHOP chemotherapy: a case report and literature review. Mycopathologia 172: 227-32, No. 3, Sep 2011 803066031 Japan
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Reactions 21 Jan 2012 No. 1385
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